Okla. Admin. Code § 317:30-5-1011

Current through Vol. 41, No. 19, June 17, 2024

Section 317:30-5-1011 - Coverage by category

Payment is made for targeted case management service as set forth in this Section.

(1)Adults. Payment is made for services to persons with an intellectual disability and/or related conditions as follows:

(A) The target group for Developmental Disabilities Services Division Targeted Case Management (DDSDTCM) services are Medicaid eligible individuals:

(i) served by the Home and Community Based Waivers operated by the Department of Human Services/Developmental Disabilities Services Division (DHS/DDSD); or

(ii) residing in institutions who:

(I) have requested Home and Community Based Waiver services operated by DHS/DDSD, and

(II) receive targeted case management services during a transition period not to exceed 180 consecutive days immediately prior to entering the Waiver; or

(iii) who are being assessed for admission to the Home and Community Based Waiver operated by DHS/DDSD.

(B) Targeted case management services may be provided when the client, the client's family as appropriate, the client's legal representative and case manager have worked together to achieve a plan.

(2)Children. Services for children are the same as for adults.

(3)Individuals eligible for Part B of Medicare. Case Management Services provided to Medicare eligible recipients are filed directly with the fiscal agent.

Okla. Admin. Code § 317:30-5-1011

Added at 14 Ok Reg 3704, eff 8-1-97 (emergency); Added at 15 Ok Reg 1528, eff 5-11-98; Amended at 18 Ok Reg 968, eff 3-21-01 (emergency); Amended at 19 Ok Reg 1067, eff 5-13-02; Amended at 29 Ok Reg 1076, eff 6-25-12